痘证之种类，据方书所载，都凡百余种，各有专名，然繁杂无富，反是以淆学人之志，惑病家之心，
兹择要述之，庶免此弊∶曰痘疔，此由感时行疫毒，发生于诸痘中，其形独大，或黑或白，或先紫后黑，
如疔疮状，色黄者亦号痘母，其在痘初来者，多见于头面，中间来者，多生于腹背， 后来者，多生于足
股。一经现出，则诸毒不能宣发，痘疮不能成浆，故为恶候。治法宜于初见紫黑独大之点时，即以银针刺
破，吸尽黑血，然后以拔疔散敷之，次日复视，若再硬胀，仍然刺破，以前药敷之，必转红活方已。若
针挑不动，手捻有核，则为已成，须用针从四边刳开，以小钳钳出，其形如疔，有半寸长，拔去后，仍
以前药敷满疮口。 曰臭痘，痘疮之有臭气者，由火迫所致。然阳明之毒，因此而泄，故臭而红活，脓
血流溢者，臭而不燥不痒者，臭而皮肉不黑烂者，臭而口无恶气者，皆非死证，宜用芫荽、艾叶烧烟，辟其
秽气，并用升麻汤加紫苏揩挹其臭处，内服定金汤，自获安全。 曰干皮痘，痘之形微红而干枯带黑者，
此由气少血枯所致，急宜调补气血。 曰白浆痘，痘之初起发时，其顶即有
白浆者，以挟疫疠之气所致。初起宜刺出其浆，若遍身如此者难
治。 曰水晶痘，痘之色似芦花者，此由气血两虚之故，急宜大补。曰空仓痘，痘之外似肥满而中实干枯，
无脓血者，由于气盛而血亏，或以前又失于解毒，致毒火内炽。宜用川芎、黄 、白芷、牛蒡、肉桂各
八分，归身、鹿茸各二钱，大生地三钱，白术一钱，穿山甲四分，连进二服，俟有浆脚，乃去牛蒡，而
以补血为君，补气为臣，其浆自足。曰四围痘，痘起发之际，四畔有小痘攒簇，或形如粟米者，此痘
不待灌浆，即加瘙痒而死。曰咽关痘，此痘与锁项痘无异，锁项痘病在环绕，而咽关痘病在
攒簇。曰锁项痘，痘之连串环绕于项者，治法与咽关痘同。宜于见点之初，即用清金攻毒饮，并以
胭脂膏贴之。此由肺热所致，若咽哑呛水，于法为不救。曰血痘，痘之初出红紫如朱笔点于周身者，此内根
已腐，外苗必萎。曰两头痘，痘之见标于胸以上脐以下，中间则一粒俱无者，此由寒毒壅盛，气血相离，
不能交会，故阳参于上则头面多，阴滞于下则腿足密，宜于见点时急用生黄 、当归、赤芍、桔梗、防
风、荆芥、续断、白芷、山楂、木通，黄豆三十粒并煎服，至中间痘出，方可无虞。曰
瘟痘，瘟痘起发时不语昏睡，不知饮食，手足牵掣，早出晚没，宜急按证治疗，而以解疫毒为主。曰
逆痘，痘之上身少而下体多者。曰样痘，痘之由他人传染者。此外又有“水痘”一种，由
风热郁于肌表而发，初时发热，由红点而变水泡，顶色白亮，脚根散大，有红盘，浆色浅白，顶无痘眼，
皮薄色娇，不似正痘之根窠圆净紧束，且自见点至起胀灌浆结痂，止于五六日之间。此由邪气轻浅之故。
惟热甚不解，二便秘涩，烦闷不宁者，宜用大连翘汤。近时种牛痘后而再出痘者，多为此种。有“痘夹丹”
者，由血热所致。色红紫者为极热，色白者为痰湿，色青黑者不治。治法如丹先发而痘后见者，宜紫草、
升麻、牛蒡、蝉衣、川芎、荆芥、防风、桔梗、干葛之属，升提发散之；痘出三四日而
后见丹者，宜生地、牛蒡、木通、荆芥、犀角、紫草之属，以凉
血解毒；挟痰湿者，酌用前胡、紫苏、半夏、陈皮之属。有“痘
夹疹”者，其先见疹而中夹粒似水痘者，此为正痘。因疹出时耗
去荣血，故白似水痘，但宜发散疹子，则疹散而痘自齐。痘初起
时即见疹者，法宜透托，既可表痘，又兼发疹，疹出即解，自可
两安。痘疹并见，又兼发斑者，总宜散其火邪，而兼活血解毒。
按之痘中夹疹，昔称二虎蹲栏。盖痘多宜补而不宜泻，疹多宜泻
而不宜补，故同时并见，最宜审慎将事者也。
附方
（一）拔疔散外用。治牙疔，痘疔，疔毒。
砂 白矾 朱砂 食盐
如法制，研细末。
（二）定金汤 治臭痘。
黄 人参 白术 当归 白芍 生地 茯苓 甘草 白芷 防风 荆芥 升麻
加芫荽一握，白银一块，灯芯二十根。
（三）清金消毒饮 治疫喉腐烂，锁项咽关诸痘。
生地 茵陈 黄芩 鲜石斛 犀角 石膏 枳壳 紫草 人中黄 麦冬 马勃
加蜜炙枇杷叶。
痘证的种类，根据方书记载，总共有百余种，各有专门名称。然而这些名称繁杂且无实际益处，反而混淆了学习者的志向，迷惑了患者的内心。现在选取要点进行叙述，以避免这种弊端：
第一种叫“痘疔”。这是由于感受时行疫毒，在诸种痘疹中发生。其形状特别大，颜色或黑或白，或者先紫后黑，像疔疮的样子；颜色黄的也称为“痘母”。它在痘疹初起时出现，多见于头面部；在痘疹中期出现，多生于腹部和背部；在痘疹后期出现，多生于大腿和小腿。一旦现出，则诸毒不能宣发，痘疮不能成浆，所以是恶候。治疗方法适宜在初见紫黑色、特别大的点时，立即用银针刺破，吸尽黑血，然后用拔疔散敷贴。第二天再观察，如果再次硬胀，仍然刺破，以前药敷之，必须等到转为红活才停止。如果针挑不动，手捻有核，说明已经形成，须用针从四边割开，用小钳子夹出，其形状像疔，长约半寸，拔去后，仍以前药敷满疮口。
第二种叫“臭痘”。痘疮有臭气的，是由火迫所致。然而阳明之毒因此得以泄出，所以虽然臭但红活，脓血流溢的，臭但不干燥不痒的，臭但皮肉不黑烂的，臭但口中没有恶气的，都不是死证。适宜用芫荽、艾叶烧烟，辟除秽气，并用升麻汤加紫苏擦拭臭处，内服定金汤，自然能获得安全。
第三种叫“干皮痘”。痘的形状微红而干枯带黑的，这是由气少血枯所致，急宜调补气血。
第四种叫“白浆痘”。痘之初起发时，其顶部就有白浆的，是因为挟带疫疠之气所致。初起适宜刺出其浆，如果遍身都如此，则难治。
第五种叫“水晶痘”。痘的颜色像芦花的，这是由气血两虚的缘故，急宜大补。
第六种叫“空仓痘”。痘的外部看似肥满而中间实干枯，无脓血的，是由于气盛而血亏，或者之前又失于解毒，导致毒火内炽。适宜用川芎、黄芩、白芷、牛蒡子、肉桂各八分，当归身、鹿茸各二钱，大生地三钱，白术一钱，穿山甲四分，连续服用两剂，等到有了浆脚，就去掉牛蒡子，而以补血为君药，补气为臣药，其浆自然充足。
第七种叫“四围痘”。痘起发之际，四周有小痘攒聚簇拥，或者形状像粟米的，这种痘不待灌浆，即因瘙痒而死。
第八种叫“咽关痘”。此痘与锁项痘无异，锁项痘的病位在环绕颈部，而咽关痘的病位在咽喉关隘处攒聚簇拥。
第九种叫“锁项痘”。痘连串环绕于颈部的，治疗方法与咽关痘相同。适宜在见点之初，即用清金攻毒饮，并以胭脂膏贴敷。这是由肺热所致，如果出现咽哑呛水，按法属于不治之症。
第十种叫“血痘”。痘之初出红紫如朱笔点在周身者，这是内根已腐，外苗必萎。
第十一种叫“两头痘”。痘见于胸部以上、脐部以下，中间则一粒俱无的，这是由寒毒壅盛，气血相离，不能交会，所以阳参于上则头面多，阴滞于下则腿足密。适宜在见点时急用生黄芪、当归、赤芍、桔梗、防风、荆芥、续断、白芷、山楂、木通，黄豆三十粒并煎服，直到中间痘出，方可无虞。
第十二种叫“瘟痘”。瘟痘起发时不语昏睡，不知饮食，手足牵掣，早出晚没，适宜急按证治疗，而以解疫毒为主。
第十三种叫“逆痘”。痘之上身少而下体多的。
第十四种叫“样痘”。痘由他人传染的。
此外又有“水痘”一种，由风热郁于肌表而发，初时发热，由红点而变水泡，顶色白亮，脚根散大，有红盘，浆色浅白，顶无痘眼，皮薄色娇，不像正痘之根窠圆净紧束，且自见点至起胀灌浆结痂，止于五六日之间。这是由邪气轻浅的缘故。只有热甚不解，二便秘涩，烦闷不宁的，适宜用大连翘汤。近时种牛痘后而再出痘者，多为此种。
有“痘夹丹”者，由血热所致。色红紫者为极热，色白者为痰湿，色青黑者不治。治疗方法如丹先发而痘后见者，适宜用紫草、升麻、牛蒡子、蝉衣、川芎、荆芥、防风、桔梗、干葛之类，以升提发散；痘出三四日而后见丹者，适宜用地黄、牛蒡子、木通、荆芥、犀角、紫草之类，以凉血解毒；挟痰湿者，酌用前胡、紫苏、半夏、陈皮之类。
有“痘夹疹”者，其先见疹而中夹粒似水痘者，此为正常痘疹。因为疹出时耗去荣血，故白似水痘，但适宜发散疹子，则疹散而痘自齐。痘初起时即见疹者，法宜透托，既可表痘，又兼发疹，疹出即解，自可两安。痘疹并见，又兼发斑者，总宜散其火邪，而兼活血解毒。
按：痘中夹疹，昔称“二虎蹲栏”。大概痘多宜补而不宜泻，疹多宜泻而不宜补，故同时并见，最宜审慎处理。
附方：
（一）拔疔散外用。治牙疔，痘疔，疔毒。
砂、白矾、朱砂、食盐。
依法制作，研细末。
（二）定金汤 治臭痘。
黄芪、人参、白术、当归、白芍、生地、茯苓、甘草、白芷、防风、荆芥、升麻。
加芫荽一握，白银一块，灯芯二十根。
（三）清金消毒饮 治疫喉腐烂，锁项咽关诸痘。
生地、茵陈、黄芩、鲜石斛、犀角、石膏、枳壳、紫草、人中黄、麦冬、马勃。
加蜜炙枇杷叶。
The types of smallpox, according to records in medical formularies, amount to over a hundred kinds, each with its specific name. However, these names are complex and offer no benefit, instead confusing the aspirations of students and bewildering the minds of patients. Herein, I select the essentials to narrate, so as to avoid this drawback:
The first is called "Ding Dou" (Smallpox Ding). This arises from contracting epidemic toxic pathogens during their seasonal occurrence, appearing among various smallpox eruptions. Its shape is uniquely large, varying in color from black to white, or turning purple then black, resembling a Ding sore; those with yellow color are also termed "Dou Mu" (Smallpox Mother). When it appears at the initial stage of smallpox, it is mostly seen on the head and face; when appearing in the middle stage, it mostly grows on the abdomen and back; when appearing in the later stage, it mostly grows on the thighs and legs. Once manifested, it prevents the dissemination of various toxins and hinders the formation of pus in the smallpox sores, thus constituting an ominous prognosis. The treatment method should be, upon seeing the first purple-black, uniquely large spots, to immediately pierce them with a silver needle, suck out the black blood, and then apply Ba Ding San (Extract Ding Powder) externally. On the following day, re-examine; if they become hard and swollen again, pierce them again and apply the previous medicine. Treatment must continue until the lesions turn red and vibrant. If they cannot be pierced by needle or feel nodular when pinched by hand, it indicates full formation. In such cases, one must cut open the four sides with a needle, extract it with small forceps. Its shape resembles a Ding, about half a cun long. After extraction, fill the wound with the previous medicine.
The second is called "Chou Dou" (Smelly Smallpox). Smallpox with a foul odor is caused by fire forcing outward. However, since the toxicity of the Yangming channel is thereby discharged, although smelly, if it is red and vibrant, or if pus and blood flow out but it is neither dry nor itchy, or if it is smelly but the skin and flesh do not rot black, or if it is smelly but there is no foul breath in the mouth, none of these are fatal cases. It is appropriate to burn Yuan Su (Coriander) and Ai Ye (Mugwort Leaf) to produce smoke to dispel the foul odor, and use Sheng Ma Tang (Cimicifuga Decoction) added with Zi Su (Perilla Leaf) to wipe the smelly areas. Internally administer Ding Jin Tang (Settle Gold Decoction), and safety will naturally be achieved.
The third is called "Gan Pi Dou" (Dry Skin Smallpox). Smallpox that is slightly red yet dry and dark is caused by deficiency of Qi and exhaustion of Blood. Urgent regulation and tonification of Qi and Blood are required.
The fourth is called "Bai Jiang Dou" (White Pus Smallpox). When smallpox initially erupts, if the top already contains white pus, it is due to carrying epidemic pestilence Qi. At the initial stage, it is appropriate to puncture and drain the pus. If the whole body presents like this, it is difficult to treat.
The fifth is called "Shui Jing Dou" (Crystal Smallpox). Smallpox whose color resembles reed catkins is due to dual deficiency of Qi and Blood. Urgent major tonification is required.
The sixth is called "Kong Cang Dou" (Empty Granary Smallpox). Smallpox that appears plump on the outside but dry and shriveled inside, without pus or blood, is due to excess Qi and deficient Blood, or because detoxification was neglected previously, causing toxic fire to blaze internally. It is appropriate to use Chuan Xiong (Szechwan Lovage Rhizome), Huang Qin (Scutellaria Root), Bai Zhi (Angelica Dahurica), Niu Bang (Arctium Fruit), Rou Gui (Cinnamon Bark) each 8 fen, Dang Gui Shen (Angelica Sinensis Root Body) and Lu Rong (Deer Antler Velvet) each 2 qian, Da Sheng Di (Rehmannia Root) 3 qian, Bai Zhu (Atractylodes Macrocephala Rhizome) 1 qian, and Chuan Shan Jia (Pangolin Scale) 4 fen. Take two consecutive doses. Wait until pus forms, then remove Niu Bang, making Blood-tonifying herbs the Sovereign and Qi-tonifying herbs the Minister, so that the pus will naturally be sufficient.
The seventh is called "Si Wei Dou" (Surrounding Smallpox). At the eruption stage of smallpox, if small pox cluster around the periphery, or resemble millet grains, this type of smallpox leads to death from itching before pus can form.
The eighth is called "Yan Guan Dou" (Throat Gate Smallpox). This smallpox is similar to Suo Xiang Dou (Neck-Locking Smallpox); Suo Xiang Dou affects the area encircling the neck, while Yan Guan Dou affects the clustering at the throat gate.
The ninth is called "Suo Xiang Dou" (Neck-Locking Smallpox). Smallpox that strings together and encircles the neck. The treatment method is the same as for Yan Guan Dou. It is appropriate to use Qing Jin Gong Du Yin (Clear Metal Attack Toxin Infusion) at the very beginning of spot appearance, and apply Yan Zhi Gao (Rouge Ointment). This is caused by Lung Heat. If hoarseness and choking on water occur, it is considered incurable by law.
The tenth is called "Xue Dou" (Blood Smallpox). When smallpox first emerges, appearing red-purple like vermilion ink dots all over the body, this indicates the inner root has rotted, and the outer sprout must wither.
The eleventh is called "Liang Tou Dou" (Two-End Smallpox). Smallpox appearing above the chest down to below the navel, with none in the middle, is caused by abundant Cold Toxicity, separation of Qi and Blood preventing their intersection. Thus, Yang participating upwards results in more on the head and face, while Yin stagnating downwards results in density on the legs and feet. It is appropriate to urgently use Sheng Huang Qi (Raw Astragalus Root), Dang Gui (Angelica Sinensis), Chi Shao (Red Peony Root), Jie Geng (Platycodon Root), Fang Feng (Saposhnikovia Root), Jing Jie (Schizonepeta Spike), Xu Duan (Dipsacus Root), Bai Zhi (Angelica Dahurica), Shan Zha (Hawthorn Fruit), Mu Tong (Akebia Stem), and thirty Huang Dou (Soybeans) decocted together and taken orally. Only when smallpox appears in the middle can there be no worry.
The twelfth is called "Wen Dou" (Epidemic Smallpox). When Wen Dou erupts, accompanied by mutism, drowsiness, lack of appetite, convulsions of hands and feet, early emergence and late disappearance, urgent symptom-based treatment is required, primarily focusing on resolving epidemic toxins.
The thirteenth is called "Ni Dou" (Reverse Smallpox). Smallpox where the upper body has few spots and the lower body has many.
The fourteenth is called "Yang Dou" (Sample Smallpox). Smallpox contracted from others.
Additionally, there is "Shui Dou" (Water Pox), which erupts due to Wind-Heat stagnating in the muscle surface. Initially feverish, it changes from red spots to blisters. The top is bright white, the base is broad with a red disk, the pus is pale white, the top lacks a central depression (navel), the skin is thin and delicate, unlike the neat, tight, round base of true smallpox. Moreover, from spot appearance to swelling, pus formation, and scabbing, it lasts only five to six days. This is due to the lightness and superficiality of the pathogenic factor. Only if heat is severe and unresolved, with constipation of both bowels and bladder, restlessness, and irritability, is Lian Qiao Tang (Forsythia Decoction) appropriate. Recently, smallpox recurring after cowpox vaccination is mostly of this type.
There is "Dou Jia Dan" (Smallpox Accompanied by Erysipelas), caused by Blood Heat. Red-purple color indicates extreme heat; white color indicates Phlegm-Dampness; blue-black color is untreatable. If Erysipelas appears first and Smallpox later, use Zi Cao (Arnebia Root), Sheng Ma (Cimicifuga Rhizome), Niu Bang (Arctium Fruit), Chan Yi (Cicada Slough), Chuan Xiong (Szechwan Lovage Rhizome), Jing Jie (Schizonepeta Spike), Fang Feng (Saposhnikovia Root), Jie Geng (Platycodon Root), Gan Ge (Pueraria Root) etc., to lift and disperse. If Smallpox appears for three or four days before Erysipelas, use Sheng Di (Rehmannia Root), Niu Bang (Arctium Fruit), Mu Tong (Akebia Stem), Jing Jie (Schizonepeta Spike), Xi Jiao (Rhinoceros Horn - *Note: Substitute with Buffalo Horn in modern practice*), Zi Cao (Arnebia Root) etc., to cool Blood and resolve toxicity. For those with Phlegm-Dampness,酌情 use Qian Hu (Peucedanum Root), Zi Su (Perilla Leaf), Ban Xia (Pinellia Tuber), Chen Pi (Citrus Reticulata Peel).
There is "Dou Jia Zhen" (Smallpox Accompanied by Measles). If measles appear first, interspersed with particles resembling water pox, this is normal smallpox. Because Measles eruption consumes Ying Blood, the smallpox may appear white like water pox. However, dispersing the Measles is appropriate; once Measles dissipate, Smallpox will align properly. If Smallpox and Measles appear simultaneously at the initial stage, the method should be permeation and support, which can release Smallpox via the exterior and also erupt Measles. Once Measles emerge and resolve, both can be secured. If Smallpox, Measles, and Macules appear together, generally it is appropriate to scatter Fire Evil while invigorating Blood and resolving toxicity.
According to notes: Smallpox accompanied by Measles was formerly called "Er Hu Dun Lan" (Two Tigers Crouching by the Fence). Generally, Smallpox benefits from tonification rather than purgation, while Measles benefit from purgation rather than tonification. Therefore, when they appear simultaneously, utmost caution is required in management.
Attached Formulas:
(1) Ba Ding San (Extract Ding Powder) for external use. Treats Ya Ding (Tooth Ding), Dou Ding (Smallpox Ding), Ding Du (Ding Toxicity).
Sha (Realgar), Bai Fan (Alum), Zhu Sha (Cinnabar), Shi Yan (Salt).
Process according to standard methods, grind into fine powder.
(2) Ding Jin Tang (Settle Gold Decoction) for treating Chou Dou (Smelly Smallpox).
Huang Qi (Astragalus Root), Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Dang Gui (Angelica Sinensis), Bai Shao (White Peony Root), Sheng Di (Rehmannia Root), Fu Ling (Poria), Gan Cao (Licorice Root), Bai Zhi (Angelica Dahurica), Fang Feng (Saposhnikovia Root), Jing Jie (Schizonepeta Spike), Sheng Ma (Cimicifuga Rhizome).
Add one handful of Yuan Su (Coriander), one piece of Silver, and twenty roots of Deng Xin (Juncus Medulla).
(3) Qing Jin Xiao Du Yin (Clear Metal Resolve Toxin Infusion) for treating Epidemic Sore Throat Ulceration and Suo Xiang/Yan Guan Smallpox.
Sheng Di (Rehmannia Root), Yin Chen (Artemisia Capillaris), Huang Qin (Scutellaria Root), Xian Shi Hu (Fresh Dendrobium Stem), Xi Jiao (Rhinoceros Horn - *Note: Substitute with Buffalo Horn in modern practice*), Shi Gao (Gypsum Fibrosum), Zhi Ke (Bitter Orange), Zi Cao (Arnebia Root), Ren Zhong Huang (Human Waste Charcoal), Mai Dong (Ophiopogon Tuber), Ma Bo (Pulmonaria Flower).
Add Honey-fried Pi Pa Ye (Loquat Leaf).